Breathing Exercises

What breathing exercises are, and what they are not

Breathing exercises are deliberate changes to the pace, depth or rhythm of your breath, and you use them to settle a body that stress has put on high alert. The instructions are usually simple: slow the breath down, let the out-breath run a little longer, and keep your attention on the breath itself.

They are a self-help skill, not a treatment for an anxiety disorder. A breathing practice can reduce the strength of a stress response, and it gives you a way to steady yourself in a difficult moment.

It does not resolve what is driving persistent anxiety, and it is not a substitute for care from a qualified professional. Used well, it runs alongside proper support rather than replacing it.

These techniques are free, portable and quick to learn. You can practise almost anywhere, no equipment is needed, and the skill stays with you once you have it.

What the evidence actually shows

The research is promising and limited at the same time.

A systematic review gathers the studies on a question and weighs them together. A 2024 review of that kind screened 309 studies and included 19 of them. Of those, twelve showed a significant improvement in anxiety and nine showed a significant improvement in stress. No adverse events were recorded across them.

The reviewers concluded that breathing exercises were effective for anxiety and stress in adults. They also noted that the evidence base still lacks large randomised controlled trials⁵. Those are studies that allocate people to groups by chance, so the comparison between groups is fair.

The direction of the findings is positive and the safety record is good, though the studies behind it are mostly small. The field has not yet produced the large trials that would settle how much benefit to expect, for whom, and for how long.

Slow breathing shifts the body towards a calmer physiological state, and many people find it helps. The effects are real but modest, and they are better evidenced for everyday stress and arousal than as a treatment for a diagnosed condition.

How slow breathing settles the body

The autonomic nervous system runs the body processes you do not consciously control; heart rate and digestion are examples. Your breathing is one of the few parts of it you can control directly. Slow the breath down and the balance shifts towards the parasympathetic side, the branch associated with rest and recovery rather than threat.

Two markers come up repeatedly in this research. Heart rate variability is the small variation in the gap between heartbeats. Respiratory sinus arrhythmia is the way that gap widens and narrows as you breathe. Both are standard signs of parasympathetic activity.

A systematic review of slow breathing, meaning a rate under 10 breaths a minute, found that these techniques increase both markers. The same review linked that autonomic shift to changes in brain activity related to emotional control, and to subjective reports of greater comfort and relaxation alongside reduced feelings of arousal and anxiety¹. The findings come from healthy volunteers, and they describe changes that occur alongside slow breathing rather than treatment outcomes.

The out-breath is the part of the cycle associated with the calming shift. That is why nearly every technique below lengthens the exhale rather than the inhale.

Some popular claims go well beyond the evidence. Slow breathing does not push extra oxygen into your brain. Nor does it cure anxiety, and there is no good basis for promises about immunity. The mechanism is a shift in autonomic balance, which is a more modest claim than the ones often made for it.

Techniques worth knowing

These practices share more than they differ, and each one slows the breath. Most lengthen the exhale, and all of them ask you to stop forcing it. Try one or two rather than working through the whole list.

Diaphragmatic breathing, also called belly breathing

Rest one hand on your chest and one on your stomach. Breathe in gently through your nose and let the breath go low, so the hand on your stomach moves more than the hand on your chest. Let the out-breath leave slowly through your mouth.

Public health guidance describes the same practice, suggesting breathing in through the nose and out through the mouth, letting the breath flow into the belly without forcing it. It also suggests counting steadily up to five on each in-breath and out-breath if that helps, and continuing for at least five minutes⁶.

This is the technique with the most direct research behind it. In one trial, 40 healthy adults were randomly assigned to diaphragmatic breathing training or a control group. The training group practised across twenty sessions over eight weeks, using a feedback device and an unusually slow rate of about four breaths a minute.

Afterwards they showed lower salivary cortisol, better sustained attention and less negative affect than at baseline, while the control group showed no change in cortisol². Cortisol is a stress hormone, and negative affect is the research term for low or unpleasant mood. The programme that produced this ran with equipment over two months, and it was not a single session on a difficult afternoon.

The extended exhale, sometimes called the physiological sigh

Take a normal breath in through the nose. Add a second, shorter breath on top of it. Then let a long, slow, unhurried breath out through the mouth, and repeat a few times.

The prolonged exhale is the element the researchers emphasised. If the double intake feels awkward, drop it and simply make the out-breath longer than the in-breath.

A randomised controlled trial compared three five minute daily breathing practices against mindfulness meditation over a month. The exhale-focused practice, which the researchers called cyclic sighing, produced greater improvement in mood and a greater reduction in breathing rate than meditation did³. The study is small and short, but it is still the clearest evidence that emphasising the out-breath does some of the work, and five minutes a day is a manageable amount.

Box breathing

Breathe in for four counts, hold for four, breathe out for four, then wait for four before starting again. The pattern is even and easy to keep track of, which is part of why it is popular in high-pressure settings.

Box breathing was one of the practices tested in the trial above³. If the holds feel uncomfortable, drop them and lengthen the out-breath instead.

The 4-7-8 breath

Breathe in through your nose for four counts, hold for seven, then breathe out through your mouth for eight. If seven counts feels like a struggle, shorten every number and keep the ratio.

Cleveland Clinic describes three cycles twice a day. It cautions that beginners may feel a little lightheaded or short of breath as the body adjusts. It advises you not to strain on the hold, and to begin at a comfortable pace rather than reaching for the full counts straight away⁷.

Equal breathing

Breathe in for a count of four and out for a count of four, keeping both halves the same length. Lengthen the count as it becomes comfortable. This is the gentlest option here, and a reasonable starting point for anyone who finds the other patterns fussy.

Where these practices come from

Controlled breathing has been taught for centuries within pranayama in yoga, within qigong in Chinese medical tradition, and within contemplative and religious practices across many cultures. Pranayama and qigong are traditional systems that include regulated breathing. Equal breathing is still widely known by its Sanskrit name, sama vritti.

Contemporary research has examined a small part of these traditions, focusing on the simple slow-breathing patterns that are easy to standardise in a trial. The research supports those specific patterns. It does not show that modern science has validated these traditions as a whole.

When breathing helps, and when it can backfire

Breathing practice does not suit every situation, and it does not suit everyone.

Where it tends to help. Breathing exercises suit ordinary stress spikes and the period before sleep. They suit the gap between one demand and the next, and the slow build of tension across a difficult day. They work best as a skill you have already practised, so the skill is there when you need it.

Where it can work against you. For some people, turning attention towards the breath makes anxiety worse rather than better. Noticing your chest, your throat and your heartbeat can make those sensations stronger, not weaker. If that is your experience, it is common. It is not a failure of technique, and you have not done it wrong.

That is a sound reason to steady yourself on something else instead. Your feet on the floor, something cold in your hands, sound around you, or gentle movement can all serve.

The popular instruction to take a big deep breath can make a panic attack worse. Research on breathing training in panic disorder found that most participants were already breathing in a way that left their carbon dioxide levels low. The usual instruction to breathe slowly could lower those levels further, because people tend to take deeper individual breaths when they feel short of air.

The treatment described in that work aimed the other way. It taught people to adjust the rate, rhythm and depth of breathing, so that carbon dioxide came back into a normal range. Improvements were seen in the treated group⁴.

If you are panicking, aim for light and slow rather than big and deep. Small, gentle breaths, with an unhurried out-breath and no gulping.

The study above describes a structured treatment delivered by clinicians with monitoring equipment. It is not a self-help exercise. It is best read as a caution against forceful deep breathing, not as instructions you can run yourself.

For people living with panic disorder, this is worth working through with a therapist rather than alone. Breathing work is part of several evidence-based therapies. It tends to be most useful when someone can tailor it to how your body actually responds.

Getting started

Begin with a small amount. A few minutes a day is a reasonable beginning. Public health guidance suggests you get the most benefit from doing it regularly, as part of your daily routine⁶.

Practise when you are already calm. A technique you have never rehearsed is hard to use in a difficult moment. Build the skill when nothing is going wrong, so that it is available when something is. Pick one technique and stay with it long enough to judge it, rather than trying them all.

Expect it to feel unremarkable at first. This is a small, cumulative practice, not a dramatic intervention. It does not need to feel profound to be doing something.

Guided audio, a breathing app or the timer on a watch can help with pacing if counting is distracting. None of that is necessary.

Teaching breathing to children and teenagers

With younger children, imagery works better than counting. Smelling a flower and blowing out a candle gives the shape of a slow in-breath and a longer out-breath, with no instruction about ratios. A soft toy resting on the stomach makes belly breathing visible. Keep it to a minute or two.

Teenagers generally do better with the reasoning behind it, and with the choice left genuinely open. Free, age-appropriate audio guides are available. A set from Nemours KidsHealth covers belly breathing and other simple practices⁸.

Pressure tends to work against you here. A young person who declines today may take it up later.

Safety, cautions and when to seek more help

For most people these practices are low risk. The systematic review noted no adverse events across the studies it included⁵. That is reassuring, but it is not the same as saying nothing can go wrong.

Mild lightheadedness, a floaty feeling or tingling in the hands can occur, particularly early on as your body adjusts to a slower pace⁷. These sensations usually pass; ease off, return to normal breathing, and try again another time with gentler counts.

Never strain on a breath hold, and drop the holds altogether if they feel uncomfortable. Stop if you feel very dizzy or unwell.

Some people should check with a doctor first. That applies if you have a health condition affecting your breathing or your heart, or if you are pregnant. Check before taking up a structured breathing practice, particularly one that involves holding the breath. And if focusing on your breath consistently raises your anxiety, stop and use a different way of steadying yourself.

Breathing exercises are also not enough on their own for some difficulties. Some signs point to a need for more: persistent anxiety, recurring panic attacks, avoiding parts of your life, or distress affecting your sleep, work or relationships all qualify.

Speak to a qualified mental health professional rather than practising harder. Effective treatments exist, and reaching for one is not a sign that you failed at the simpler thing.

None of the above is a substitute for individual advice from a professional who knows your circumstances. If breathing practice is not enough on its own, that is useful information rather than a setback. For anyone at that point, what to look for when choosing a therapist is a reasonable thing to read next.

This article is for general information and is not a substitute for professional assessment or care. If this is affecting your life, consider reaching out to a qualified mental health professional.

References

1. [1] Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353. https://doi.org/10.3389/fnhum.2018.00353
2. [2] Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., Wei, G.-X., & Li, Y.-F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874
3. [3] Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895
4. [4] Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2008). Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. Journal of Psychiatric Research, 42(7), 560-568. https://doi.org/10.1016/j.jpsychires.2007.06.005
5. [5] Morgan, S. P., Lengacher, C. A., & Seo, Y. (2024). A systematic review of breathing exercise interventions: An integrative complementary approach for anxiety and stress in adult populations. Journal of Holistic Nursing, 43(4). https://doi.org/10.1177/08980101241273860
6. [6] National Health Service. (n.d.). Breathing exercises for stress. https://www.nhs.uk/mental-health/self-help/guides-tools-and-activities/breathing-exercises-for-stress/
7. [7] Cleveland Clinic. (2022, September 6). How to do the 4-7-8 breathing exercise. https://health.clevelandclinic.org/4-7-8-breathing
8. [8] Nemours KidsHealth. (n.d.). Relaxation exercises: Breathing basics (for teens). https://kidshealth.org/en/teens/relax-breathing.html